Mendelsohn A M, Bove E L, Lupinetti F M, Crowley D C, Lloyd T R, Beekman R H
Department of Pediatrics, University of Michigan Medical Center, Ann Arbor 48109-0204.
J Thorac Cardiovasc Surg. 1994 May;107(5):1284-90.
The changes in pulmonary artery size and hemodynamics in 30 patients with univentricular cardiac anatomy were examined before and after bidirectional Glenn procedures done between October 1989 and February 1992. Serial angiographic and hemodynamic examinations before and 17.6 +/- 1.6 months after bidirectional Glenn procedures were compared. At the follow-up study there was no significant change in diameter of the pulmonary artery ipsilateral to the bidirectional Glenn shunt, however, a significant decrease was noted in the diameter of the pulmonary artery contralateral to the bidirectional Glenn shunt (p = 0.04). There was also a 32% decrease in the Nakata index of total cross-sectional pulmonary artery area after the bidirectional Glenn procedure (p = 0.004). Total pulmonary blood flow and mean pulmonary artery pressure had decreased, and arterial oxygen saturation had increased at follow-up. These changes, however, did not correlate with the observed changes in pulmonary artery size. By linear regression analysis, a significant relationship was identified between the Nakata index before the bidirectional Glenn procedure and the absolute change in Nakata index (r = 0.83). A significant decrease in Nakata index occurred only in patients with a bidirectional Glenn shunt in place more than 15 months. Sixteen of the 30 patients subsequently underwent total cavo-pulmonary anastomosis with 7 requiring concurrent surgical pulmonary artery reconstruction. Changes in pulmonary artery size observed more than 15 months after the bidirectional Glenn procedure may have implications for subsequent Fontan repair in children with univentricular anatomy.
对1989年10月至1992年2月期间接受双向格林手术的30例单心室心脏解剖患者的肺动脉大小和血流动力学变化进行了术前和术后检查。比较了双向格林手术前及术后17.6±1.6个月的系列血管造影和血流动力学检查结果。在随访研究中，双向格林分流同侧的肺动脉直径无显著变化，然而，双向格林分流对侧的肺动脉直径显著减小（p = 0.04）。双向格林手术后，肺动脉总横截面积的中田指数也下降了32%（p = 0.004）。随访时，肺总血流量和平均肺动脉压下降，动脉血氧饱和度升高。然而，这些变化与观察到的肺动脉大小变化无关。通过线性回归分析，确定双向格林手术前的中田指数与中田指数的绝对变化之间存在显著关系（r = 0.83）。仅在双向格林分流超过15个月的患者中，中田指数出现显著下降。30例患者中有16例随后接受了全腔静脉-肺动脉吻合术，其中7例需要同时进行外科肺动脉重建。双向格林手术后超过15个月观察到的肺动脉大小变化可能对单心室解剖结构儿童的后续Fontan修复有影响。
